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Enucleations and Eviscerations for Combat Ocular Trauma Performed During Operations Iraqi and Enduring Freedom

2001 to 2011

Stevens, Bryan J., BS*; Justin, Grant A., MD†,‡; Reed, Donovan S., MD‡,§; Jaksha, Alexandria F., MD||; Davies, Brett W., MD‡,§; DeMartelaere, Sherri L., MD; Ryan, Denise S., MS; Weichel, Eric D., MD#; Colyer, Marcus H., MD‡,**

Journal of Craniofacial Surgery: May 2019 - Volume 30 - Issue 3 - p 767–770
doi: 10.1097/SCS.0000000000005294
Original Articles

Purpose: To describe the demographics and clinical outcomes of patients who underwent posttraumatic enucleation or evisceration during Operations Iraqi Freedom (OIF) and Enduring Freedom (OEF) from 2001 to 2011.

Methods: The Walter Reed Ocular Trauma Database is a retrospective case series of US Servicemembers and Department of Defense civilians who had combat ocular injuries in OIF and OEF. Data regarding posttraumatic enucleations and eviscerations performed during OIF and OEF were extracted. The main outcomes analyzed were the number of enucleations and eviscerations performed, location of the surgery, laterality, and graft type. The secondary outcome measures included: mechanism of injury and Ocular Trauma Score classification.

Results: One hundred nine enucleations and eviscerations were performed on the 890 eyes (12.24%). Sixty-three (57.80%) primary enucleations, 36 (33.03%) secondary enucleations, 5 (4.59%) postretinal detachment repair enucleations, and 5 (4.59%) primary eviscerations were completed. The surgeries were completed at a combat support hospital (57; 52.3%), or Walter Reed Army Medical Center (49; 45.0%). All surgeries were unilateral except in 2 patients. The most common graft type used was silicone (n = 56; 51.38%). Improvised explosive devices caused 76 (69.72%) eye injuries. Ocular Trauma Score were recorded as 56 (51.38%) between 0 and 44, 44 (40.37%) between 45 and 65, and unknown in 9 (8.26%).

Conclusion: Posttraumatic enucleation or evisceration due to devastating ocular trauma is required in about 15% of ophthalmic patients in modern combat trauma. The psychosocial impact on veterans who have required an enucleation or evisceration from combat trauma has been poorly studied and requires further review.

*School of Medicine, Uniformed Services University of the Health Science, Bethesda, MD

Department of Ophthalmology, Brooke Army Medical Center, San Antonio, TX

Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD

§Department of Ophthalmology, Wilford Hall Eye Center

||Department of General Medical Education, Brooke Army Medical Center, San Antonio, TX

Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, VA

#Retina Group of Washington D.C., Greenbelt

**Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, MD.

Address correspondence and reprint requests to Grant A. Justin, MD, Brooke Army Medical Center, San Antonio, TX; E-mail:

Received 14 July, 2018

Accepted 3 December, 2018

This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs under the Broad Agency Announcement for Extramural Medical Research, BAA-16-R-BAA1 under Award No. W81XWH-17-2-0007.

The authors report no conflicts of interest.

The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, the Department of Defense, the Uniformed Services University of the Health Sciences, or any other agency of the US Government.

© 2019 by Mutaz B. Habal, MD.